Provider Demographics
NPI:1538816582
Name:PRINCE, ALBERTA SUE
Entity type:Individual
Prefix:
First Name:ALBERTA
Middle Name:SUE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 S 600 W TRLR 28
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-5056
Mailing Address - Country:US
Mailing Address - Phone:208-821-5702
Mailing Address - Fax:
Practice Address - Street 1:17 S 600 W TRLR 28
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-5056
Practice Address - Country:US
Practice Address - Phone:208-821-5702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care